Doppler-Based Renal Resistive Index: A Comprehensive Review

  • M. Darmon
  • D. Schnell
  • F. Zeni
Conference paper

Abstract

Renal sonography is performed routinely to assess renal and collecting system morphology. B-mode sonography provides valuable information on anatomic features including kidney size (longitudinal diameter and parenchyma thickness) and appearance (kidney margins and echogenicity of the parenchyma, cortex, medulla, and papillae); presence and degree of hydronephrosis; and presence of stones, calcification, cysts, or solid masses. However, B-mode sonography does not evaluate kidney function. Renal Doppler, in contrast, helps to assess renal perfusion and renal function of native or transplanted kidneys (Fig. 1). Renal Doppler is valuable for assessing large arterial or venous abnormalities and has been suggested for evaluating changes in intrarenal perfusion due to diseases of the renal parenchyma [1, 2, 3, 4, 5]. The Doppler-based renal resistive index is a recently suggested tool for assessing changes in renal perfusion in critically ill patients [6, 7, 8] and for predicting acute kidney injury (AKI) in patients with severe sepsis [9]. However, many factors influence the renal resistive index and should be taken into account when interpreting resistive index values in critically ill patients [10].

Fig.1.

Example of an intrarenal arterial Doppler waveform

Keywords

Dopamine Norepinephrine Resis Cyclosporine Pyramid 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Krumme B, Blum U, Schwertfeger E, et al (1996) Diagnosis of renovascular disease by intraand extrarenal Doppler scanning. Kidney Int 50: 1288–1292CrossRefGoogle Scholar
  2. 2.
    Allen KS, Iorkasky DK, Arger PH, et al (1988) Renal allografts: prospective analysis of Doppler sonography. Radiology 169: 371–376PubMedGoogle Scholar
  3. 3.
    Buckley AR, Cooperberg PL, Reeve CE, Magil AB (1987) The distinction between acute renal transplant rejection and cyclosporine nephrotoxicity: value of duplex sonography. AJR Am J Roentgenol 149: 521–525PubMedGoogle Scholar
  4. 4.
    Patriquin HB, O'Regan S, Robitaille P, Paltiel H (1989) Hemolytic-uremic syndrome: intrarenal arterial Doppler patterns as a useful guide to therapy. Radiology 172: 625–628PubMedGoogle Scholar
  5. 5.
    Platt JF, Rubin JM, Ellis JH, DiPietro MA (1989) Duplex Doppler US of the kidney: differentiation of obstructive from nonobstructive dilatation. Radiology 171: 515–517PubMedGoogle Scholar
  6. 6.
    Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D, Duranteau J (2007) Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography. Intensive Care Med 33: 1557–1562CrossRefPubMedGoogle Scholar
  7. 7.
    Duranteau J, Deruddre S, Vigue B, Chemla D (2008) Doppler monitoring of renal hemodynamics: why the best is yet to come. Intensive Care Med 34: 1360–1361CrossRefPubMedGoogle Scholar
  8. 8.
    Lauschke A, Teichgraber UK, Frei U, Eckardt KU (2006) ‘Low-dose’ dopamine worsens renal perfusion in patients with acute renal failure. Kidney Int 69: 1669–1674CrossRefPubMedGoogle Scholar
  9. 9.
    Lerolle N, Guerot E, Faisy C, Bornstain C, Diehl JL, Fagon JY(2006) Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 32: 1553–1559CrossRefPubMedGoogle Scholar
  10. 10.
    Murphy ME, Tublin ME (2000) Understanding the Doppler RI: impact of renal arterial distensibility on the RI in a hydronephrotic ex vivo rabbit kidney model. J Ultrasound Med 19: 303–314PubMedGoogle Scholar
  11. 11.
    Platt JF (1992) Duplex Doppler evaluation of native kidney dysfunction: obstructive and nonobstructive disease. AJR Am J Roentgenol 158: 1035–1042PubMedGoogle Scholar
  12. 12.
    Barozzi L, Valentino M, Santoro A, Mancini E, Pavlica P (2007) Renal ultrasonography in critically ill patients. Crit Care Med 35 (5 Suppl): S198–205CrossRefPubMedGoogle Scholar
  13. 13.
    Keogan MT, Kliewer MA, Hertzberg BS, DeLong DM, Tupler RH, Carroll BA (1996) Renal resistive indexes: variability in Doppler US measurement in a healthy population. Radiology 199: 165–169PubMedGoogle Scholar
  14. 14.
    Norris CS, Pfeiffer JS, Rittgers SE, Barnes RW (1984) Noninvasive evaluation of renal artery stenosis and renovascular resistance. Experimental and clinical studies. J Vase Surg 1: 192–201Google Scholar
  15. 15.
    Bude RO, DiPietro MA) Platt JF, Rubin JM, Miesowicz S, Lundquist C (1992) Age dependency of the renal resistive index in healthy children. Radiology 184: 469–473PubMedGoogle Scholar
  16. 16.
    Terry JD, Rysavy JA, Frick MP (1992) Intrarenal Doppler: characteristics of aging kidneys. J Ultrasound Med 11: 647–651PubMedGoogle Scholar
  17. 17.
    el Helou N, Helenon O, Augusti M, et al (1993) [Renal Doppler ultrasonography in the diagnosis of acute obstructions of the upper urinary tract]. J Radiol 74: 499–507PubMedGoogle Scholar
  18. 18.
    Mostbeck GH, Gossinger HD, Mallek R, Siostrzonek P, Schneider B, Tscholakoff D (1990) Effect of heart rate on Doppler measurements of resistive index in renal arteries. Radiology 175: 511–513PubMedGoogle Scholar
  19. 19.
    Vade A, Dudiak C, McCarthy P, Hatch DA, Subbaiah P (1999) Resistive indices in the evaluation of infants with obstructive and nonobstructive pyelocaliectasis. J Ultrasound Med 18: 357–361PubMedGoogle Scholar
  20. 20.
    Platt JF (1997) Duplex Doppler evaluation of acute renal obstruction. Semin Ultrasound CT MR 18: 147–153CrossRefPubMedGoogle Scholar
  21. 21.
    Mostbeck GH, Kain R, et al (1991) Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation. J Ultrasound Med 10: 189–194PubMedGoogle Scholar
  22. 22.
    Jensen G, Bardelli M, Volkmann R, Caidahl K, Rose G, Aurell M (1994) Renovascular resistance in primary hypertension: experimental variations detected by means of Doppler ultrasound. J Hypertens 12: 959–964CrossRefPubMedGoogle Scholar
  23. 23.
    Bude RO, Rubin JM (1999) Stenosis of the main artery supplying an organ: effect of endorgan vascular compliance on the poststenotic peak systolic velocity. J Ultrasound Med 18: 603–613PubMedGoogle Scholar
  24. 24.
    Tublin ME, Tessler FN, Murphy ME (1999) Correlation between renal vascular resistance, pulse pressure, and the resistive index in isolated perfused rabbit kidneys. Radiology 213: 258–264PubMedGoogle Scholar
  25. 25.
    Kirkpatrick AW, Colistro R, Laupland KB, et al (2007) Renal arterial resistive index response to intraabdominal hypertension in a porcine model. Crit Care Med 35: 207–213CrossRefPubMedGoogle Scholar
  26. 26.
    Platt JF, Ellis JH, Rubin JM, DiPietro MA, Sedman AB (1990) Intrarenal arterial Doppler sonography in patients with nonobstructive renal disease: correlation of resistive index with biopsy findings. AJR Am J Roentgenol 154: 1223–1227PubMedGoogle Scholar
  27. 27.
    Ikee R, Kobayashi S, Hemmi N, et al (2005) Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J Kidney Dis 46: 603–609CrossRefPubMedGoogle Scholar
  28. 28.
    Radermacher J, Mengel M, Ellis S, et al (2003) The renal arterial resistance index and renal allograft survival. N Engl J Med 349: 115–124CrossRefPubMedGoogle Scholar
  29. 29.
    Aikimbaev KS, Canataroglu A, Ozbek S, Usal A (2001) Renal vascular resistance in progressive systemic sclerosis: evaluation with duplex Doppler ultrasound. Angiology 52: 697–701CrossRefPubMedGoogle Scholar
  30. 30.
    Platt JF, Rubin JM, Ellis JH (1997) Lupus nephritis: predictive value of conventional and Doppler US and comparison with serologic and biopsy parameters. Radiology 203: 82–86PubMedGoogle Scholar
  31. 31.
    Sari A, Dine H, Zibandeh A, Telatar M, Gumele HR (1999) Value of resistive index in patients with clinical diabetic nephropathy. Invest Radiol 34: 718–721CrossRefPubMedGoogle Scholar
  32. 32.
    Frauchiger B, Nussbaumer P, Hugentobler M, Staub D (2000) Duplex sonographic registration of age and diabetes-related loss of renal vasodilatory response to nitroglycerine. Nephrol Dial Transplant 15: 827–832CrossRefPubMedGoogle Scholar
  33. 33.
    Petersen LJ, Petersen JR, Talleruphuus U, Ladefoged SD, Mehlsen J, Jensen HA (1997) The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure. Nephrol Dial Transplant 12: 1376–1380CrossRefPubMedGoogle Scholar
  34. 34.
    Don S, Kopecky KK, Filo RS, et al (1989) Duplex Doppler US of renal allografts: causes of elevated resistive index. Radiology 171: 709–712PubMedGoogle Scholar
  35. 35.
    Rifkin MD, Needleman L, Pasto ME, et al (1987) Evaluation of renal transplant rejection by duplex Doppler examination: value of the resistive index. AJR Am J Roentgenol 148: 759–762PubMedGoogle Scholar
  36. 36.
    Perrella RR, Duerinckx AJ, Tessler FN, et al (1990) Evaluation of renal transplant dysfunction by duplex Doppler sonography: a prospective study and review of the literature. Am J Kidney Dis 15: 544–550PubMedGoogle Scholar
  37. 37.
    Kelcz F, Pozniak MA) Pirsch JD, Oberly TD (1990) Pyramidal appearance and resistive index: insensitive and nonspecific sonographic indicators of renal transplant rejection. AJR Am J Roentgenol 155: 531–535PubMedGoogle Scholar
  38. 38.
    Genkins SM, Sanfilippo FP, Carroll BA (1989) Duplex Doppler sonography of renal transplants: lack of sensitivity and specificity in establishing pathologic diagnosis. AJR Am J Roentgenol 152: 535–539PubMedGoogle Scholar
  39. 39.
    Trillaud H, Merville P, Tran Le Linh P, Palussiere J, Potaux L, Grenier N (1998) Color Doppler sonography in early renal transplantation follow-up: resistive index measurements versus power Doppler sonography. AJR Am J Roentgenol 171: 1611–1615PubMedGoogle Scholar
  40. 40.
    Lebkowska U, Malyszko J, Lebkowski W, et al (2007) The predictive value of arterial renal blood flow parameters in renal graft survival. Transplant Proc 39: 2727–2729CrossRefPubMedGoogle Scholar
  41. 41.
    Radmehr A, Iandaghi AB, Hashemi Taheri AP, Shakiba M (2008) Serial resistive index and pulsatility index for diagnosing renal complications in the early posttransplant phase: improving diagnostic efficacy by considering maximum values. Exp Clin Transplant 6: 161–167PubMedGoogle Scholar
  42. 42.
    Nezami N, Tarzamni MK, Argani H, Nourifar M (2008) Doppler ultrasonographic indices after renal transplantation as renal function predictors. Transplant Proc 40: 94–99CrossRefPubMedGoogle Scholar
  43. 43.
    Amis ES) Jr., Cronan JJ, Pfister RC, Yoder IC (1982) Ultrasonic inaccuracies in diagnosing renal obstruction. Urology 19: 101–105CrossRefPubMedGoogle Scholar
  44. 44.
    Platt JF, Rubin JM, Ellis JH (1989) Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography. AJR Am J Roentgenol 153: 997–1000PubMedGoogle Scholar
  45. 45.
    Gottlieb RH, Luhmann Kt, Oates RP (1989) Duplex ultrasound evaluation of normal native kidneys and native kidneys with urinary tract obstruction. J Ultrasound Med 8: 609–611PubMedGoogle Scholar
  46. 46.
    Onur MR, Cubuk M, Andie C, Kartal M, Arslan G (2007) Role of resistive index in renal colic. Urol Res 35: 307–312CrossRefPubMedGoogle Scholar
  47. 47.
    Tublin ME, Dodd GD 3rd, Verdile VP (1994) Acute renal colic: diagnosis with duplex Doppler US. Radiology 193: 697–701PubMedGoogle Scholar
  48. 48.
    Gurel S, Akata D, Gurel K, Ozmen MN, Akhan 0 (2006) Correlation between the renal resistive index (RI) and nonenhanced computed tomography in acute renal colic: how reliable is the RI in distinguishing obstruction? J Ultrasound Med 25: 1113–1120PubMedGoogle Scholar
  49. 49.
    Platt JF (1994) Looking for renal obstruction: the view from renal Doppler US. Radiology 193: 610–612PubMedGoogle Scholar
  50. 50.
    Stevens PE, Gwyther SJ, Hanson ME, Boultbee JE, Kox WJ, Phillips ME (1990) Noninvasive monitoring of renal blood flow characteristics during acute renal failure in man. Intensive Care Med 16: 153–158CrossRefPubMedGoogle Scholar
  51. 51.
    Izumi M, Sugiura T, Nakamura H, Nagatoya K, Imai E, Hori M (2000) Differential diagnosis of prerenal azotemia from acute tubular necrosis and prediction of recovery by Doppler ultrasound. Am J Kidney Dis 35: 713–719CrossRefPubMedGoogle Scholar
  52. 52.
    Platt JF, Rubin JM, Ellis JH (1991) Acute renal failure: possible role of duplex Doppler US in distinction between acute prerenal failure and acute tubular necrosis. Radiology 179: 419–423PubMedGoogle Scholar
  53. 53.
    Wan L, Yang N, Hiew CY, et al (2008) An assessment of the accuracy of renal blood flow estimation by Doppler ultrasound. Intensive Care Med 34: 1503–1510CrossRefPubMedGoogle Scholar
  54. 54.
    Bude RO, Larson RG, Nichols WW, Rubin JM (1999) Stenosis of the main artery supplying an organ: effect of end-organ vascular resistance on the poststenotic peak systolic velocity in an in vitro hydraulic model at Doppler US. Radiology 212: 79–87PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2010

Authors and Affiliations

  • M. Darmon
    • 1
  • D. Schnell
    • 2
  • F. Zeni
    • 1
  1. 1.Medical-Surgical Intensive Care UnitSaint-Etienne University HospitalSaint-Priest-en-JarezFrance
  2. 2.Medical Intensive Care UnitSaint-Louis University HospitalParisFrance

Personalised recommendations